NCG081031_Application _20221117

FOR AGENCY USE ONLY
NCG08 I Q 3 1
Assignedto: B.— GOO'
ARO FRO MRO RRO WAR WIRO WSRO
RECEIVED
ND QUALITY
Division of Energy, Mineral, and Land Resourcestaird''C�fl WMQn
National Pollutant Discharge Elimination System
NCG080000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC40 [Railroad Transportation], SIC41 [Local and Suburban Transit and Interurban
Highway Passenger Transportation], SIC 41 ]Motor Freight Transportation and Warehousing — except for SIC
4221-4225], SIC 43 [United States Postal Services], SIC 5171 [Petroleum Bulk Stations and Terminals — when total
petroleum site storage capacity is less than 1 million gallons]. The following activities are also included: other
industrial actives where the vehicle maintenance area(s) are the only area requiring permitting; stormwater
discharges from oil water separators and/or from secondary containment structures associated with petroleum
storage facilities with less than 1 million gallons of total petroleum site storage capacity. You can find information
on the DEMLR Stormwater Program at deq.nc.gov/SW
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program, 1612 MSC, Raleigh, NC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (7) below:
Waste Industries, LLC
Tim Black
Street address:
City:
State:
Zip Code:
3301 Benson Drive, Suite 301
Raleigh
NC
27609
Telephone number:
Email address:
[phone]
[e-mail]
Type of Ownership:
Government
❑County ❑Federal ❑Municipal ❑State
Non -government
Il Business (If ownership is business, a copy of NCSOS report must be included with this application)
❑Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
GFL Pas uotank Hauling Facility
Joseph Santangelo
Street address:
City:
State:
Zip Code:
657 Old US HWY 17S
Elizabeth City
NC
27909
Parcel Identification Number (PIN):
County:
799203101472
Pasquotank
Telephone number:
Email address:
252 264-2996
Joseph.Santangelo@gflenv.00m
4-digit SIC code:
Facility is:
Date operation is to begin or began:
4212
1 ❑ New ❑ Proposed El Existing
1990's
Latitude of entrance:
Longitude of entrance:
36014'58.02"N
76" 18'57.98"W
Page 1 of 5

Brief description of the types of industrial activities and products manufactured at this facility:
Waste container storage, vehicle maintenance, and vehicle parking
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
❑ N/A
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Travis Martinez
Golder Associates NC, Inc.
Street address:
City:
State:
Zip Code:
5 B Oak Branch Drive
Greensboro
NC
27407
Telephone number:
Email address:
[phone]
travis.martinez wsp.com
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
Name of receiving water:
Classification:
❑This water is impaired.
SDO-1
Little River
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
36014'59.77"N
76'19'01.030W
Brief description of the industrial activities that drain to this outfall:
Waste container storage, vehicle maintenance, and vehide parking
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Il Yes ® No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Approximately 34
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes 13 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NOI.
Page 2 of 5

S. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
O This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Stone water drains
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
A DRAFT SWPPP (Golder) is in progress. Once a COC# Is issued, COC# will be added to SWPPP, finalized, and issued to Facility.
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked, indicate:
Kilograms of waste generated each month:
Type(s) of waste:
How material is stored:
Where material is stored:
Number of waste shipments per year:
Name of transport/disposal vendor:
Transport/disposal vendor EPA ID:
Vendor address:
❑ This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
0 Check for $100 made payable to NCDEQ
0 Copy of most recent Annual Report to the NC Secretary of State
O This completed application and any supporting documentation
O A site diagram showing, at a minimum, existing and proposed:
a) outline of drainage areas
b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
f) areas where industrial process materials are stored
g) impervious areas
h) site property lines
0 Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant Certification:
North Carolina General Statute 143-215.68 (i) provides that: Any person who knowingly makes any false statement,
representation, or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
171`am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
Iivil or criminal penalties incurred due to violations of this permit.
O'The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
will abide by all conditions of the NCG080000 permit. I understand that coverage under this permit will constitute the
hermit requirements for the discharge(s) and is enforceable in the same manner as an individual permit.
5 I hereby request coverage under the NCGO80000 General Permit.
Printed Name of Applicant: Tim Black
Title: Facility Manager
�,
(Sig t ruan(Sig a of Applicant) (Da& Si ed)
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes E3 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-0 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur In the drainage area of this outfall? E3 Yes ® No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:❑
This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

LIMITED LIABILITY COMPANY ANNUAL REPORT
U6/=
NAME OF LIMITED LIABILITY COMPANY: Waste Industries, LLC
SECRETARY OF STATE ID NUMBER: 0565738 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2022 AMFNDING DOC ID
x
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: CT Corporation System
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
0565738
CA202206303714
3/4/2022 02:15
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200
160 Mine Lake Ct Ste 200
Raleigh, NC 27615 Wake County Raleigh, NC 27615
SECTION B:
1. DESCRIPTION OF NATURE OF BUSINESS: Waste Management
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
3301 Benson Drive, Suite 601
NC 27609
5. PRINCIPAL OFFICE MAILING ADDRESS
3301 Benson Drive
NC 27609
6. Select one of the following If applicable. (Optional see Instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Waste Industries USA, LLC NAME: Waste Industries USA, LLC NAME:
TITLE: Manager TITLE: Member TITLE:
ADDRESS:
ADDRESS:
ADDRESS:
3301 Benson Drive Ste. 601 3301 Benson Drive Ste. 601
Raleigh, NC 27609 Raleigh, NC 27609
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a personibusiness entity.
Waste Industries USA, LLC, by Natalie Pickens® POA 3/4/2022
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Waste Industries USA; LLC, by Natalie PickensE PDA Manager
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

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G[GREEN FOR LIFE
environmental corporation
CHEQUE REQUEST
Payable to:
NCDEQ
Date:
06/01 /2022
Amount:
$100.00
Description:
Stormwater Program Permit
Cheque Required by (Date): ...... 06/10/2022 ..............................................................................................................
Address: where the Cheque to be mailed out/couriered: ...... 657 Old US Hwy 17 South ........................
.. ... .... I-- ............. .......................... I .................. I ..... ...... Elizabeth City, NC 27909..........................
Isthis new vendor (Yes/No): . . .......... No...............................................................................................
If Yes, please get the vendor set up by through vendor management (Email: Vendormanagementta"-gflenv com)
Once the vendor is set-up, please process this cheque request form as an invoice in ETS and send an email to
VaunhanAPUrgent(a)gflenV com.
OFFICE USE ONLY
Approved by
Apply to GL #
Cheque #
Revised: December 16,2020 A-21